Karpathiou Georgia, Chauleur Celine, Dal Col Pierre, Dridi Maroa, Laville David, Mobarki Mousa, Peoc'h Michel
Pathology and Gynecology/Obstetrics, University Hospital of Saint-Etienne, France.
Gynecology/Obstetrics Departments, North Hospital, University Hospital of Saint-Etienne, France.
Pathol Res Pract. 2020 Aug;216(8):152992. doi: 10.1016/j.prp.2020.152992. Epub 2020 May 4.
Endometrial ablation for abnormal uterine bleeding is used as a less invasive alternative to hysterectomy, however, in cases of treatment failure hysterectomy may be finally performed. The histologic changes in these post-treatment uteri are not well-described.
To describe the histological findings in post-endometrial ablation uteri.
During a ten-year period, 321 patients were treated with endometrial ablation. Twenty-five patients (7.8%), 10 treated with NovaSure® and 15 treated with ThermaChoice® endometrial ablation were finally subjected to hysterectomy mostly due to persistent uterine bleeding. Histologic features of these hysterectomies are described.
The patients' age ranged from 33 to 73 years (mean 44.5) and 34-53 (mean 42) for the NovaSure® and ThermaChoice® group, respectively. The time from endometrial ablation to hysterectomy was 2-24 months (mean 8.8) and 2-60 months (mean 23.2) for the two groups, respectively (p = 0.01). Hysterectomies performed later (mean 22 months) showed no fibrosis (p = 0.04) compared with those performed earlier (mean 5 months). Endometrial lining was found more frequently in hysterectomies performed later (mean 13 months) than those performed earlier (mean 2 months, p = 0.0004). Abundant necrotic tissue of myometrial origin was found in 28% of the cases, but it was not associated with the time of hysterectomy (p = 0.2). A zonation effect and vascular changes also seen. Granulomatous reaction was not found. Ten patients (40%) harbored adenomyosis and another three (12%) extensive leiomyomas/diffuse leiomyomatosis.
Necrosis, fibrosis and vascular changes are found during the first year of post-thermal uterine effect. Hysterectomies performed later show less prominent changes and almost normal endometrial lining. Adenomyosis is found in an important part of post-endometrial ablation hysterectomies.
子宫内膜去除术用于治疗异常子宫出血，是子宫切除术侵入性较小的替代方法，然而，在治疗失败的情况下最终可能仍需进行子宫切除术。这些治疗后子宫的组织学变化尚无详尽描述。
描述子宫内膜去除术后子宫的组织学发现。
在十年期间，321例患者接受了子宫内膜去除术。25例患者（7.8%）最终接受了子宫切除术，其中10例采用NovaSure®子宫内膜去除术治疗，15例采用ThermaChoice®子宫内膜去除术治疗，主要原因是持续子宫出血。描述了这些子宫切除术的组织学特征。
患者年龄范围为33至73岁（平均44.5岁），NovaSure®组和ThermaChoice®组分别为34至53岁（平均42岁）。两组从子宫内膜去除术到子宫切除术的时间分别为2至24个月（平均8.8个月）和2至60个月（平均23.2个月）（p = 0.01）。与较早进行的子宫切除术（平均5个月）相比，较晚进行的子宫切除术（平均22个月）未显示纤维化（p = 0.04）。在较晚进行的子宫切除术（平均13个月）中，发现子宫内膜层的情况比早期（平均2个月）更为常见（p = 0.0004）。28%的病例中发现大量子宫肌层来源的坏死组织，但这与子宫切除术的时间无关（p = 0.2）。还观察到分区效应和血管变化。未发现肉芽肿反应。10例患者（40%）患有子宫腺肌病，另外3例（12%）患有广泛的平滑肌瘤/弥漫性平滑肌瘤病。
在热损伤子宫效应的第一年可发现坏死、纤维化和血管变化。较晚进行的子宫切除术显示变化不那么明显，子宫内膜层几乎正常。子宫腺肌病在子宫内膜去除术后子宫切除术中占相当比例。
